Sub fascial placement of breast implants has been proposed as a technique that has many of the advantages of sub glandular and sub muscular placement without the adverse outcomes. There are few large series with longitudinal follow up and defined outcome measures.
This talk reviews seven hundred and eighty-three patients that underwent subfascial breast augmentation and were followed up for ten years. A series of simple standard measurements are described and how they can be used to examine changes in breast shape. Adverse outcomes, patient satisfaction and sensory deficits are also presented.
All breast morphometry measurements increased following surgery except soft tissue thickness at the lateral sternal margin (LSM). The distance from the nipple areolar complex (NAC) to inframammary crease (NAC-IMC) increased by an average of 40%, with a concomitant 6.2% increase in the distance from the supra-sternal notch (SSN) to NAC. Capsular contraction rates were 6.48% at ten years, and correlates with an LSM of less than 20mm (r=0.57, p<0.001), but no other variable. Ripples occurred in patients with less than 10mm of soft tissue at the LSM. Using a base width-based sizing system, 11.6% would choose a larger implant and 2.7% a smaller size. An attempt to quantify the match is presented.
Subfascial placement of breast implants provides a reliable technique of breast augmentation. Simple morphometric measurements demonstrate it can be confidently used in patients with at least 20 mm of soft tissue at the LSM. Simple measurements and questions undertaken before and after surgery can provide invaluable information on which studies can be expanded and improved.

Download